This is a submission for an NIDDK K23 Mentored Patient-Oriented Research Career Development Award (PA- 11-194). Dr. Emily Schroeder's overarching career goal is to be a leader in the conduct of research that improves the lives of individuals with diabetes. Her research explores the treatment of blood pressure on the progression of diabetic kidney disease. Candidate: Dr. Schroeder is an Investigator at the Institute for Health Research at Kaiser Permanente Colorado and an Endocrinologist at Kaiser Permanente Colorado. She has prior training in epidemiology and endocrinology, and an early track record of publications and research funding. Training: The proposed K23 career development plan builds upon Dr. Schroeder's prior experience in epidemiology and endocrinology to focus on two areas that require additional training: 1) Methods for observational comparative effectiveness research, and 2) Conduct of pragmatic clinical trials. Accordingly, Dr. Schroeder proposes intensive topical mentorship, focused coursework, seminars, and contextual learning through the proposed research. Mentors/Environment: Dr. Schroeder and her primary mentor, Dr. John Steiner, have assembled a strong mentorship team who will guide Dr. Schroeder through the proposed training and research activities. This mentorship team includes expertise in nephrology, biostatistics, pragmatic clinical trials, and translational research. Her research will take place within the Institute for Health Research, which has a long history of leadership in national research networks. This research uses a large, innovative, and newly created database of over one million individuals with diabetes across 11 U.S. health maintenance organizations. Research: Diabetic kidney disease is a major cause of morbidity and mortality in the United States. Aim 1 is a study of the comparative effectiveness and safety of second-line blood pressure agents for the treatment of diabetic kidney disease to determine if there is a class effect independent of level of achieved blood pressure control. Aim 2 extends the findings of Aim 1 to examine the effect of ongoing treatment with different second- line blood pressure agents, as opposed to the effect of initial treatment assignment determined in Aim 1. Aim 3 is a pilot pragmatic clinical trial to improve blood pressure control among individuals with both diabetes and stage 3 chronic kidney disease. Summary: Conduct of this mentored research and training proposal, Blood Pressure and Progression of Diabetic Kidney Disease, will facilitate Dr. Schroeder's development into a nationally-recognized independent investigator and leader conducting research to improve the lives of individuals with diabetes.